下肢血管微创介入在缺血型糖尿病足中的应用效果分析

【摘要】目的 探讨下肢血管微创介入在缺血型糖尿病足中的应用效果。方法 选取2013年8月至2018年6月牡丹江心血管病医院糖尿病分院内分泌科收治的116例糖尿病足患者作为研究对象,并按照不同干预方法将其分为观察组（60例,92处创面）与对照组（56例,70处创面）,观察组患者在常规综合治疗的基础上行下肢血管微创介入治疗,对照组患者在常规综合治疗的基础上行保守溶栓治疗,对比观察两组患者踝肱指数（ankle brachial index,ABI）、创面愈合率、临床疗效及截肢情况。结果 治疗第7、28天,观察组患者ABI均显著高于对照组（t=9.909、8.575,P均=0.000）;治疗第28天,观察组患者创面愈合率显著高于对照组（t=10.930,P=0.000）,临床疗效显著优于对照组（Z=-3.550,P=0.000）;治疗过程中,观察组患者截肢率明显低于对照组（χ2=10.881,P=0.004）。结论 下肢血管微创介入治疗能够有效改善糖尿病足患者下肢血液供应,降低截肢率或截肢平面,促进创面愈合,改善患者预后。     

糖尿病双下肢血管病变介入治疗的护理循证

目的:讨论糖尿病双下肢血管病变介入治疗的护理循证。方法:将36例糖尿病双下肢血管病变的患者随机分为两组:保守组和治疗组。保守组18例,除控制血糖、抗感染、清疮、换药外,应用东菱克栓酶静脉滴注一疗程后,经多普勒超声观察双下肢血管的变化;治疗组18例,先给予控制血糖、抗感染、有关糖尿病护理等治疗后,分别行病变血管球囊扩张术介入治疗,术后6个月复查血管造影。结果:治疗组患者治疗后当即皮温升高,血液供应明显改善,足背动脉搏动增强。通过对糖尿病患者的护理、控制血糖、局部换药等治疗措施,足部溃疡愈合较快,近期疗效显著。结论:糖尿病双下肢血管病变血管内介入治疗创伤小,安全有效,临床症状改善明显,可重复性强。通过对患者术前准备及护理、术中配合、术后护理及观察,可以缩短住院天数,提高手术成功率以及患者的生活质量,并降低患者的致残率。     

浅谈糖尿病足的护理体会

糖尿病足是糖尿病周围血管神经病变的严重并发症之一,主要因为下肢中小血管病变以及微循环障碍,周围神经病变并发感染所致,早期以双足感受麻木、发凉、疼痛为主要表现。常致足部溃疡坏疽甚至截肢,严重危胁着糖尿病患者的健康,通过临床治疗及护理,可控制坏疽的发生发展,降低截肢率,减轻病人的痛苦。现将我们收治的12例急性糖尿病足患者的护理体会报告如下。     

脐血干细胞移植治疗糖尿病下肢血管病变15例护理体会

糖尿病引起的下肢血管阻塞而造成下肢远端组织缺血、缺氧,发生溃疡后并发感染,溃疡不易愈合,最后发生坏疽,致残率高,预后较差,最终的结局是溃疡、截肢和死亡。据报道,50岁以上的糖尿病患者下肢血管病变的发病率为25%～30%[1]。早期有效的治疗决定预后,因此我们必须重视。     

糖尿病下肢动脉病变彩色多普勒超声诊断及相关危险因素分析

糖尿病下肢动脉血管病变（lower extremity arterial disease,LEAD）亦称外周血管病变（peripheral vascular disease,PVD）、外周动脉病变（peripheral arterial disease,PAD）。糖尿病下肢动脉血管病变是糖尿病的主要并发症之一,导致糖尿病足部溃疡（diabetic foot ulceration）,病变严重造成下肢截肢。糖尿病是一个全身性动脉系统血管疾病[1]。     

美宝湿润烧伤膏对糖尿病下肢溃疡创面愈合的影响

目的:探讨美宝湿润烧伤膏(MEBO)对糖尿病下肢溃疡创面愈合的影响.方法:于2004年11月～2007年6月对收治的60例糖尿病溃疡患者随机分为两组,实验组采用MEBO治疗,对照组采用常规换药治疗,比较两组疗效的差异,对临床治疗过程进行全面观察.结果:实验组中30例溃疡创面全部治愈,与对照组相比,有显著意义.同时观察到创面的再生修复过程及其规律性.结论:MEBO可促进糖尿病下肢溃疡创面愈合,其药理学作用是综合治疗的结果.     

糖尿病足治疗新进展

糖尿病足是由于糖尿病血管神经病变引起的下肢病变的总称,是糖尿病的严重并发症.其病因主要为糖尿病合并血管病变、神经病变、各种损伤及感染所致.目前的治疗方法主要为：1.基础治疗：控制血糖、抗感染、改善血液循环及神经功能等; 2.局部创面治疗：湿润烧伤膏（MEBO）、凝胶制剂、生长因子等; 3.外科手术治疗：手术植皮、介入疗法、血管重建术、神经松解术等.临床体会：在基础治疗全身状况稳定后,创面局部清创,外用MEBO 能够显著提高创面愈合率,避免截肢之苦.     

糖尿病足介入治疗的几个问题

糖尿病足的血管检查应以超声检查为首选,其次为CTA和MRA,最后为血管造影,DSA检查应视为金标准。糖尿病足病变主要由小动脉病变和微循环障碍引起,因此除局部血管成形,置放内支架外,局部药物灌注治疗极其重要。糖尿病是一个全身性疾病,糖尿病足的治疗不仅要注重血管腔内局部治疗,还应全身药物治疗,应用活血化瘀,改善微循环药物,包括糖尿病治疗。对糖尿病足疗效不只是评价血管狭窄与再狭窄,应该包括临床症状缓解情况,保肢和降低截肢平面等。     

凯时治疗糖尿病下肢血管病变的多普勒超声观察及护理

目的:探讨多普勒超声对凯时治疗糖尿病下肢血管病变的观察价值及临床护理要点。方法:对97例糖尿病下肢血管病变应用凯时治疗的患者采用多普勒超声进行血液动力学、血管内径及频谱宽度的观察,并与正常组进行了对照。结果:97例糖尿病下肢血管病变的患者经凯时治疗后,多普勒超声显示病变的血管内径增宽,血流量增加,频谱宽度变窄及相应的临床症状减轻或消失。结论:应用多普勒超声可动态、实时、准确地对病变血管作出诊断,对其预后和护理有一定指导意义     

糖尿病足的相关因素及下肢血管介入治疗的效果分析

糖尿病足是2型糖尿病严重的并发症之一,常导致下肢疼痛、跛行、感觉异常、皮肤深溃疡甚至肢体坏疽.目前,尚无有效的治疗手段.但早期干预和处理糖尿病足发病危险因素,能有效预防和减少糖尿病足的发生.后期可采用下肢血管介入治疗,能使糖尿病足患者获得良好的临床效果.     

一站式治疗重症缺血性糖尿病足感染15例

目的 总结重症缺血性糖尿病足感染创面的一站式治疗经验.方法 回顾性分析2015年6月至2016年4月收治的15例重症缺血性糖尿病足坏疽患者(15条患肢)临床资料.对所有患者采用腔内修复术(EVR)开通闭塞段血管、手术清创及创面封闭负压引流(NPWT)、抗菌保湿伤口敷料进行一站式序贯治疗,评价感染创面愈合率及患肢保肢率.结果 15例患者中下肢动脉造影显示下肢多节段病变13例,单纯小腿病变2例;泛大西洋学会联盟(TASC)Ⅱ分级D级小腿动脉病变13条,C级病变2条.EVR术后,14条患肢至少开通1支小腿流出道;足底动脉环路(PPL)呈完整弓6例,半弓7例,无弓2例;清创后应用带自制冲洗设备NPWT,创面感染控制时间为(7.85±2.84)d.出院后每3～4日随访,并以抗菌保湿的磺胺嘧啶银脂质水胶伤口敷料换药,结果显示创面愈合12例,平均愈合时间(3.70±0.87)个月,3例未愈合,其中2例小腿截肢(13.3％,足部均为PPL无弓),1例死于心血管事件;创面愈合组PPL病变情况与未愈合组比较,差异有显著统计学意义(P=0.006 7).结论 重症缺血性糖尿病足感染治疗较复杂.EVR、带自制冲洗设备NPWT及抗菌保湿创面敷料一站式联合治疗,可作为首选方法有效增加患肢血供,缩短感染控制时间,降低截肢率.     

糖尿病足截肢前后血管内介入治疗临床分析

目的评价糖尿病足患者截肢前、后血管内治疗的临床效果和必要性。方法14例患者,其中截肢前血管内治疗10例,截肢后治疗4例,累及血管包括股浅动脉、股深动脉和胫、腓动脉,其中17支血管行血管内球囊成型治疗,同时结合局部扩血管药物灌注。结果所有患者血管内治疗均获成功,所有患者肢体血供明显改善,有效促进截肢后伤口愈合。无并发症。结论糖尿病足截肢前、后血管内介入治疗是安全和有效的,具有积极作用。     

经皮腔内血管成形术治疗糖尿病足的临床研究

目的 评价经皮腔内血管成形术治疗糖尿病足的临床价值.资料与方法 回顾性分析糖尿病足患者资料28例,息肢32条,治疗使用专用球囊进行扩张,观察术中血管再通及治疗前后病情改善情况.结果 所有患者血管内治疗均获成功,肢体血供明显改善,有效促进糖尿病足溃疡愈合.结论 经皮腔内血管成形术治疗糖尿病足安全、有效,具有十分重要的临床价值,值得临床上广泛推广.     

The diabetic foot: Charcot joint and osteomyelitis

Foot problems are common causes of disability in diabetic patients with as many as 25% expected to develop severe foot or leg problems during their lifetimes. Although skin ulceration is the most frequent problem, bones may also be involved in two different clinical conditions: osteomyelitis and Charcot osteoarthropathy. Osteomyelitis causes complications in up to one third of diabetic foot infections and is due to direct contamination from a soft-tissue ulcer. Osteoarthropathy Charcot foot is a chronic and progressive disease of the bone and joints. Both osteomyelitis and Charcot joint are conditions with an increased risk of lower limb amputation, both may have a successful outcome when recognized and treated in the early stages. The major diagnostic difficulty is in distinguishing bone infection (osteomyelitis) from non-infectious neuropathic bony disorders as in osteoarthropathy Charcot foot. An additional difficulty is found when a bone infection superimposes a Charcot osteopathy. This condition, which can be clinically suspected when foot ulceration appears in Charcot foot, needs to be diagnosed because it implies a different therapeutic strategy. This article aims to summarize both these two clinical conditions and give indications to make a timely and correct diagnosis.     

Management of the insensitive foot in diabetes: lessons learned from Hansen's disease

Diabetes mellitus is the number one cause of lower extremity amputation (LEA) in the United States, accounting for about 60,000 cases per year. While the combination of reduced blood supply and the loss of sensation to the foot in a diabetic are responsible for the high incidence of LEAs, in most cases it is the loss of sensation that is primarily responsible for the initial foot wound and its failure to heal. The authors review the four mechanical causes for foot ulceration and eventual amputation. Based on an understanding of how feet ulcerate, the National Foot Treatment Center in Carville, LA has developed an insensitive foot screening and treatment program for "diabetic" foot ulcers that is more than 90% effective in healing plantar ulcers.     

膝下动脉球囊成形术及溶栓介入治疗糖尿病足的价值(附19例分析)

目的:探讨膝下动脉球囊成形术及保留导管溶栓术在介入治疗糖尿病足的临床价值。方法:对19例糖尿病足患者介入术前行CTA检查,对31个下肢用Seldinger技术,经股动脉顺行穿刺插管,分别对膝下动脉病变采用经血管腔内球囊成形术、保留导管溶栓术等多种介入治疗方法。结果:介入治疗后患肢血流改善明显,狭窄性病变开通率明显大于闭塞性病变。皮温明显升高,行走距离显著增加,溃疡愈合加快。结论:膝下动脉球囊成形术及保留导管溶栓治疗微创、安全、有效,可以改善糖尿病足下肢动脉血供,近期疗效令人满意。     

从MEBO治愈102例糖尿病足浅析创面处理与治疗规范

目的探讨以保全肢体、终止截肢为临床治疗终点的Wagner3—5级糖尿病足创面的临床处理与治疗规范。方法以102例Wagner3～5级糖尿病足患者创面采用MEBO＋外科清创术治愈的经验为依据,归纳总结wagner,3～5级糖尿病足创面的临床处理与治疗规范。结果从102例Wagner3～5级糖尿病足创面获得治愈的临床证据充分表明,MEBO＋外科清创术对Wagner3～5级糖尿病足创面的治疗效果显著。结论MEBO＋外科清创术能实现患肢保全、终止截肢的临床治疗终点,叮作为Wagner3—5级糖尿病足创面的临床处理与治疗规范。     

MEBO联合微粒皮种植术治愈1例糖尿病足截肢后残端创面

目的探讨糖尿病足创面的修复方法。方法对1例糖尿病足截肢患者截肢后的残端创面用湿润烧伤膏(MEBO)换药治疗30 d后,在肉芽组织中种植微粒皮修复创面。结果微粒皮种植术后65 d,患者截肢后残端创面完全愈合。结论 MEBO联合微粒皮种植术是一种全新的、技术要求简单、手术限制条件少,并且能降低截肢平面的治疗糖尿病足的方法。     

3D CE-MRA在老年糖尿病病人下肢动脉疾病中的应用进展

糖尿病为老年人的常见病、多发病,其可并发多器官疾病,其中下肢动脉疾病是老年糖尿病病人最常见的慢性并发症之一,临床表现重者可出现下肢缺血性坏疽,甚至有截肢的可能。准确评价下肢动脉疾病对其临床诊断和治疗有重要意义。三维对比增强磁共振血管成像（3D CE-MRA）已经成为综合评价下肢动脉疾病的主要方法,对3D CE-MRA的成像原理及其在老年糖尿病病人下肢动脉疾病中的临床应用进展进行综述。     

Subintimal angioplasty of infrapopliteal artery occlusions in the treatment of critical limb ischaemia. Short-term results

AIM: To evaluate the feasibility and efficacy of subintimal infrapopliteal angioplasty (SIA) as a method for recanalization of occluded tibial arteries in the treatment of critical limb ischaemia (CLI). MATERIALS AND METHODS: Between January 2002 and September 2003, 20 patients with CLI were submitted to SIA; of these, 16 had diabetes mellitus. All patients had foot ulceration or gangrene and ten had rest pain. All patients were treated with SIA of one or more vessels of the popliteal district. Overall, thirty-four arteries of the infrapopliteal district underwent revascularization; in 9 cases, SIA of superficial femoral artery occlusions was associated. Technical success was evaluated on angiography at the end of the procedure: revascularization of at least one of the 3 leg vessels with re-establishment of arterial flow to the foot was regarded as a technical success. Pain relief (when pain was present) and healing of foot ulceration, without above-the-ankle major amputation (limb salvage), were defined as clinically successful. During the follow-up (mean: 9 months; range: 6-21 months) all patients were checked 6 months after the procedure by clinical examination and colour-Doppler ultrasound. RESULTS: The technical success rate of SIA in the revascularization of the infrapopliteal vessels was 85%. In the 17 technically successful cases, pain had entirely resolved in 9/10 cases and trophic lesions of the foot healed in 14/17 cases. In this group, 9 patients underwent minor amputation; 2 underwent major above-the-ankle amputation; one underwent to surgery 20 days after the SIA and required a femoro-tibial by-pass. In the 3 cases of technical failure (15%), revascularization of the entire occluded tract could not be achieved. Of these, one patient subsequently underwent major amputation. Nine months after SIA, the cumulative limb salvage rate was 85% (17/20 clinically successful cases) and the survival rate was 90%. Colour-Doppler US at 6 months showed 70% primary patency. No major complication occurred during the procedure. Five minor complications in four patients were managed endovascularly or healed spontaneously. CONCLUSIONS: SIA is a feasible and effective technique for foot revascularization in patients with CLI. Long occlusions or diffusely calcified arteries are suitable indications. Technical failure does not preclude conventional surgery. In patients treated with SIA, the risk of major amputation is low and mortality rate is nil. Minor complications can be managed using endovascular techniques.